Abstract
Background and aim
Atrial Fibrillation is the leading cause of embolic stroke, yet less than half of
high-risk patients with atrial fibrillation are on adequate stroke prevention with
oral anticoagulants. Guidelines for the primary prevention of stroke recognize the
emergency department as a location for physicians to identify atrial fibrillation
and initiate anticoagulants. We sought to compare anticoagulant prescription rates
in patients with atrial fibrillation in various provider settings to identify opportunities
for improvement in cardioembolic stroke prevention.
Methods
A retrospective cohort study of 436 patients with atrial fibrillation presenting to
the emergency department from 2014 to 2018 was performed. Baseline characteristics,
stroke risk, and rates of anticoagulant prescription were compared across 3 groups:
(1) patients discharged from the emergency department, (2) patients admitted under
observation status, and (3) patients admitted to inpatient hospital service.
Results
Among 436 patients (47% women, 51% Hispanic), we identified 105 in the emergency department
cohort, 131 in the observation cohort and 200 in the inpatient cohort. The average
CHA2DS2-VASc score was 2.5 in the emergency department cohort, 2.6 in the observation cohort
and 3.3 in the inpatient cohort. Anticoagulants were prescribed for high-risk patients
(CHA2DS2-VASc score ≥ 2) in 17.5% (7/40) of the emergency department cohort compared to 73%
(38/52, P< .0001) of the observation cohort and 80% (82/103 P< .0001) of the inpatient cohort.
Conclusion
Patients with atrial fibrillation are more likely to be prescribed anticoagulants
if admitted to inpatient or under observation status compared to the emergency department.
Key Words
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Article info
Publication history
Published online: January 27, 2020
Accepted:
December 10,
2019
Received in revised form:
December 3,
2019
Received:
October 17,
2019
Footnotes
Work was performed at Jackson Memorial Health Systems, Emergency Department and University of Miami: Miller School of Medicine, Department of Neurology.
Disclosures: Dr. Seemant Chaturvedi and Dr. Lilly Lee each receive funding from Boehringer-Ingelheim Pharmaceuticals, Inc.
No grant support was received for this project.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104599
Copyright
© 2019 Elsevier Inc. All rights reserved.
